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Background: While antipsychotic (AP) medications are frequently used in long-term care, current evidence suggests that the risks may offset the benefits, necessitating periodic reassessment of their use. The aims of this present study were: (1) to assess rates of AP use five years after our first intervention to determine the long-term impact; and (2) to implement an updated AP reduction educational intervention program at the same center five years later in order to determine whether AP use could be further reduced.

Methods: Participants were residents with dementia receiving AP medication. The educational program component included separate lectures on pharmacologic and non-pharmacologic treatment of behavioral and psychological symptoms of dementia (BPSD). Completion of the Nursing Home Behavior Problems Scale (NHBPS), physician interviews concerning AP treatment plans for subjects with dementia, and AP administration and dose assessment occurred both at baseline and again between four to five months after the educational program.

Results: Of 308 long-term residents with dementia, 53 (17.2%) were receiving regular APs, primarily for agitation, aggressivity, other behavioral problems and psychosis. Of these, six died and one was transferred, leaving 46 participants. At five months, ten (21.7%) residents were no longer receiving APs and seven (15.2%) were on a lower dose; thus, 17 (37.0%) were either discontinued or on a lower dose. There was no worsening of NHBPS scores.

Conclusion: Despite the low prevalence (17.2%) of AP users at the beginning of the current study compared to that observed five years prior (30.5%), it is still possible to further decrease the proportion of users.

Frailty puts individuals at increased risk for poor health outcomes. Elderly individuals use a disproportionate amount of emergency department (ED) resources. To investigate the relationship between frailty markers and the effect on ED use by community-dwelling seniors, we conducted a secondary analysis of a 22-month prospective randomized control trial in Montreal, Canada, using the Service Intégrés pour les Personnes Âgées en Perte d’Autonomie (SIPA) database. We assessed a sample of 565 individuals using five frailty markers: physical activity, strength, cognition, energy, and mobility. Univariate and multivariable logistic regression was performed to assess for potential relationship between frailty markers and ED visits. The findings revealed that 70 per cent of the participants had at least three frailty markers. No relationship was found between frailty markers and ED visits. These results suggest that in severely functionally disabled, community-dwelling elderly, the presence of frailty markers does not appear to predict ED visits.

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